“Love hurts and relationships just bring pain,” said Melissa,* a 17 year-old student at Revere High School.  Melissa’s first serious relationship began when she was 14, with a 19 year-old man.  It started out with all the hopes of a first love and feelings of complete joy that this man took such an interest in her. Slowly the red flags began to appear in Melissa’s relationship over the first six months.  He was possessive, jealous, told her what he wanted her to wear, accused her of cheating, isolated her from her friends and tried to prevent her from using birth control. Soon her grades dropped and he discouraged her from going to school.  She eventually dropped out.

When Melissa contracted a sexually transmitted disease, she visited the MGH school based health center.  There she met an advocate from HAVEN, the MGH domestic violence program, who screens all young women using the center.  She gradually came to trust the advocate and eventually joined a weekly support group. This connection allowed Melissa ongoing access to voices that challenged the messages her abuser was feeding her.  Melissa used a respite created by her boyfriend’s six month incarceration to set goals for herself and decided to return to school.  She continues to struggle with disconnecting from him completely, but has grown in confidence.  Through its continuum of care for adolescents in Revere, MGH continues to help this young woman challenge generational patterns and inspire hope for the future.

* names and details have been changed to protect confidentiality

Violence is prevalent throughout our society, with much of it taking place in the home.  This violence has profound health and mental health effects.  Fully 25 percent of women experience intimate partner abuse at some point in their lives, with pregnancy being one of the most vulnerable times. Children who witness violence can suffer deep trauma.  Half of all children in households where domestic violence is taking place are also abused. 
MGH Center for Community Health Improvement has developed a number of programs to respond to intimate partner and family violence. MGH Chelsea has several programs that seek to heal the trauma experienced by children witnessing violence.  Across the MGH system, the HAVEN program advocates for those experiencing abuse from their intimate partners, and trained specialists help providers throughout the hospital when child abuse or neglect is suspected. 

Child Protection Consultation Team
Susan Lipton, LICSW, Program Director
Alice Newton, MD, Medical Director

The mission of the Child Protection Consultation Team (the Team) is:

To provide the highest standard of care to children who may have experienced or are suspected of experiencing abuse or neglect and their families; and to provide all clinicians who care for children with the basic skills and knowledge necessary to provide the full range of appropriate support and service to children and their families: i.e., screen, identify, assess, intervene, refer, and follow-up on suspected cases of child abuse and neglect.

The Child Protection Consultation Team provides leadership to the MGH’s response to issues of child abuse and neglect. The Team is comprised of a Program Director, Medical Director, part-time Clinical Social Worker and part-time Pediatrician. Consultation from the Team is available to providers throughout MGH, twenty-four hours a day, seven days a week, to assist with the assessment and management of suspected cases of child maltreatment. Requests for consultations come from Pediatrics, the Emergency Department, Obstetrics, HAVEN, Adult Medicine, Mental Health, MGH health centers in Charlestown, Chelsea and Revere, the West End Clinic, and other MGH and community providers.

The Team works closely with many disciplines and departments within MGH, including clinical social workers, physicians, nurses, HAVEN advocates, psychiatrists, Police and Security, and attorneys. In addition, the Team interfaces with multiple community agencies including the Massachusetts Department of Social Services (DSS), local police departments, district attorney offices, and the courts. The Team also participates in multidisciplinary interagency committees, including the Suffolk County Children’s Advocacy Center and its Advisory Board; a committee that has developed Guidelines for Mandated Reporters Responding to the Co-occurrence of Domestic Violence and Child Abuse and is now developing a statewide training initiative for its implementation by DSS staff and community providers; and a committee that is looking at hospital based child protection teams across the state. The medical director participates in the Violence Committee of the Massachusetts Medical Society, continuing efforts in the development of a Shaken Baby Syndrome awareness and prevention initiative in Suffolk County, and advocacy for statewide legislation on child abuse prevention. 

The Team provides interdisciplinary training to staff, on the medical and psychosocial aspects of child maltreatment, in a variety of educational forums throughout MGH and the community. Outreach and training to staff of all disciplines continues to be a major priority for the Child Protection Consultation Team

2006 Program Data

• The Team provided consultations to clinicians in more than 600possible cases of child abuse and neglect during the last year.
• Reports of suspected child abuse and neglect were filed with the Massachusetts Department of Social Services on behalf of children in fewer than 50 percent of these cases. 

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HAVEN
Ann Daniels, MSW PhD Interim Director, Social Service Department
Bonnie Zimmer, LICSW, Director, HAVEN

Mission and Goal

HAVEN works as part of the broader movement to end intimate partner abuse by improving and enhancing our health care response to MGH patients, employees, and community members who have been impacted by abuse.

HAVEN’s goal is to reduce the immediate impact of violence on survivors and their families, and to help individuals and families seek lives free of violence and abuse. MGH HAVEN serves patients and employees, including the MGH health centers.  HAVEN also trains and consults with MGH providers and other caregivers to screen, identify and respond empathically to survivors of abuse.  In addition, HAVEN advises the hospital on the development of domestic violence policy and protocols, in keeping with guidelines set forth by the Joint Commission.

HAVEN Services and Activities

Advocacy

HAVEN provides welcoming, affirming advocacy and supportive services to all survivors, beginning in the dating years through later life, through a culturally diverse and linguistically supportive array of services.

HAVEN provides ongoing individual counseling and advocacy services to survivors identified by MGH and health center providers, or who self-identify. HAVEN helps survivors understand that they are not at fault for the abuse they suffer, that they are not alone but rather are joined by many others who share similar experiences, and that there is help available both at MGH and in their communities. HAVEN helps connect survivors to needed services, provides information and referrals relating to the legal aspects of domestic violence, and if needed accompanies survivors to health care, legal or other appointments. In order to respond to an especially urgent and violent trend of increased sexual assault and trafficking in our communities, HAVEN has broadened its framework of domestic violence in order to respond to victims in these complex circumstances.

HAVEN is committed to delivering culturally and linguistically appropriate services. Four of the six HAVEN staff are multilingual and provide services in French, Spanish, Haitian Creole and English. Printed program materials are available in English, Spanish, and Khmer.

With the ongoing support of State Street Global Philanthropies, HAVEN has hired a training and prevention coordinator to update and enhance HAVEN’s training capacity, and to explore opportunities to expand our prevention efforts with adolescents and youth in our communities. 

Support Groups

HAVEN is especially proud of its comprehensive support group programming. Groups are offered in English at MGH, Seacoast Academy (Revere) and MGH Revere, and in Spanish at MGH Chelsea. In HAVEN groups, women who have survived abuse come together to share resources, learn about abuse and its impacts, and encourage and inspire one another in their journey towards safety and healing. The groups play an important role in enabling survivors to move forward with their lives.

Specialized Adolescent Services

With funding from the Massachusetts Office of Victim Assistance (MOVA), HAVEN continues its innovative adolescent health work. A HAVEN advocate provides services to all patients of the Adolescent Health Clinic at MGH Revere. Also in Revere, a “Healthy Relationships Working Group” comprised of school, health and community partners coordinates services to students and training initiatives. HAVEN participates in Teen Dating Violence Awareness Week and Health Education Outreach to eighth grade students in Revere middle schools. A brochure on healthy relationships and dating violence, developed by an MGH Revere HAVEN advocate and teens has been widely distributed in Revere as a way to outreach to Revere youth. HAVEN recently had the opportunity to train nurse practitioners statewide in some of the techniques developed through this innovative work.

Health Professions Education

HAVEN helps prepare new health care providers through its active internship programs with graduate programs in the Boston area.  Interns assist with client work, facilitate support groups, and conduct research initiatives and other individually designed projects.  This year HAVEN added Tufts University School of Medicine and Suffolk University’s Masters Program in Women’s Health as new educational collaborators.

New Educational Initiative

This year marked HAVEN’s tenth  anniversary at MGH.  The program launched a focused educational and outreach campaign entitled,  “Is Your Relationship Affecting Your Health?”  This innovative brochure, developed with funding from an MGH Making A Difference Grant, and informed by focus groups of providers and consumers,  features checklists, questionnaires, helpful hints, and quotes from survivors. The brochure is available in English and Spanish and helps readers explore questions such as: “Is my relationship healthy... or not?” “How could my health be affected?” “What about my children?” and “Who is Affected?” Another section entitled, “Are you a health-care provider?” offers information about the health impacts of intimate-partner abuse, tips for screening and responding to patients who disclose abuse, referring and consulting with the HAVEN program and how to request staff training, which HAVEN offers throughout the hospital and health centers.

Research and Evaluation

HAVEN uses evaluation to make needed improvements to its programming. HAVEN participated in a study funded by the Agency for Healthcare Research and Quality to validate a new DV Program Client Feedback Form and this year began using the form in clinical work with plans to analyze the data to study program outcomes. HAVEN and the MGH Gillette Center for Women’s Cancer completed a groundbreaking study on a the impact of domestic violence on cancer treatment this year.  The study, funded by the National Cancer Institute, involved in-depth interviews in English and Spanish with patients who have faced cancer while in an abusive relationship. Findings are being analyzed and will be used to educate oncology providers about the impact of domestic violence on cancer treatment and will inform domestic violence guidelines for use in oncology clinics.  HAVEN continues to participate in the dissemination of information gathered through our collaborative research with Dr. Liz Miller of the University of California, Davis.  

Partnerships

HAVEN maintains numerous partnerships in the service of our clients. The Hospital Project of Greater Boston Legal Services, funded through the U.S. Department of Justice, provides legal services to eligible HAVEN clients. HAVEN is an active member of the Conference of Boston Teaching Hospital’s Domestic Violence Advisory Council, the Chelsea and Revere Domestic Violence Task Forces, and SAGE-Boston. HAVEN is also represented on the NASW Committee on Domestic Violence and Sexual Assault, and the Revere School-based Health Center Advisory Committee.  HAVEN is an active member of Jane Doe, Inc., the Massachusetts Coalition against Sexual Assault and Domestic Violence.

Program Data

• Since 1997, HAVEN has provided services to 4,057 patients, employees and MGH visitors.
• During this time, HAVEN has offered over 3,700 consultations to clinicians.
• 34 percent of overall program clients identify as Latina, 10% Black, 5% Asian, 45% White and 6 percent other.  Forty-one percent of HAVEN clients are between the ages of 20 and39, 43 percent between 40 and59 with 9 percent under the age of 20, and 7 percent over the age of 60.  96 percent of clients served were female. 
• Services were provided in languages other than English (Spanish, French, Haitian Creole) in 24 percent of client contacts

Children's Witness to Violence
Katherine Griffiths, LICSW, MGH Chelsea

MGH Chelsea is the recipient of a generous, multi-year grant from the Massachusetts Department of Social Services (DSS) to work toward helping children affected by domestic violence.  The goal of the Children’s Witness to Violence Program is to reduce the impact of family violence on families with  children.  Children’s Witness to Violence serves children ages seven to seventeen  and their families who have witnessed and/or experienced violence in their homes or communities.  Children’s Witness to Violence clients may have previously received or are currently receiving services from PACT, HAVEN (described below), Pediatrics and other MGH Chelsea departments, or may be referred from community organizations.

The complex nature of situations in which children witness or directly experience physical and/or emotional abuse requires ongoing and effective communication among a number of players.  These include DSS, and Harbor COV, the Chelsea domestic violence program, attorneys, guardians ad litem, the MGH Child Protection Team, and other community agencies. 

Children’s Witness to Violence services are uniquely designed to respond to the particular needs of young children, through mental health assessments, clinical follow-up, case management, and treatment.   Therapeutic groups for mothers and their children conducted simultaneously have been a particularly effective intervention.  One of the groups is for mothers and children  ages seven to eleven affected by domestic violence, using a curriculum developed by MGH clinicians is now used statewide. Groups are also run for mothers and their preschoolers ages 4 to 6, using a curriculum designed by MGH clinicians and a group from The Cambridge Guidance Center.  Lastly, mothers and their adolescents participate in separate groups , then meet together for dinner, both using the ARC (attachment, regulation and competency) curriculum designed by the Trauma Center in Brookline.

2007 Program Accomplishments
Groups for children who have been exposed to violence ages four to fourteen (including younger siblings of the referred child) have been fully implemented and have served approximately two dozen families.  The Children’s Witness to Violence Program has served almost every family that has been referred. 

Program Data

In 2007, Children’s Witness to Violence committed to serve at least 22 children and their families in total for the year.  Most of these families continue in treatment for a minimum of two months.

• As a part of the Massachusetts Department of Social Services’ grant network, the Children’s Witness to Violence Program meets at least quarterly with domestic violence agencies statewide regarding collaboration.

Police Action Counseling Team - PACT
Georgia Green, LICSW, MGH Chelsea 
Thomas Dunn, Lieutenant, Chelsea Police Department

The goal of the Police Action Counseling Team (PACT), founded in 1998, is to reduce the immediate impact of trauma on children who witness violence in Chelsea.  Ultimately, PACT seeks to reduce the effects of trauma on a child's ongoing development, and to interrupt the cycle of family violence.  PACT is a partnership between the MGH Chelsea, the Chelsea Police Department, the MGH Child Protection Consultation Counseling Team, and the MA Department of Social Services (DSS).  PACT clinical social workers are available by beeper 24 hours a day, seven days a week for on-the-scene response to 911 calls when children are present.  Once police officers establish physical safety, social workers provide on-site developmentally appropriate interventions by helping children to express their fears, sadness, anxiety, hope and other feelings, providing information and answering questions so that children can feel more in control of their circumstances, and helping children identify and undertake immediate next steps, such as gathering belongings if they need to relocate, or arranging for transportation to school the next day.

PACT social workers also help parents and other family members understand the short and long-term effects of violence on children, provide them with language-appropriate resource materials, and offer assistance in managing the symptomatic aftermath of such incidents. PACT connects families with services, such as medical and mental health care, domestic violence shelters, court advocates, and facilitates connections with school personnel, clergy, and whomever the family identifies as a support network.  Weekly team meetings at the Chelsea Police station with social workers, police officers, and DSS assure all are communicating effectively on behalf of the family. 

2007 Program Accomplishments

• PACT provided training to MGH psychology and social work interns, and psychiatry residents as part of their community medicine rotations.  Additionally, interns and residents can opt to ride with police to gain exposure and insight into the crises that families face that can result in the need for medical and mental health interventions.  
• New police officers were oriented to PACT as part of their general orientation when joining the Chelsea PD.
• PACT was chosen by the American Hospital Association for its January, 2007 publication, Community Connections, Ideas & Innovations for Hospital Leaders.
• PACT began a new process of rotating officers through weekly PACT meetings, to involve officers in the discussion and follow up on cases they have paged on.  This process also provides ongoing officer training and assists program development.
• PACT personnel participated in a strategic planning meeting at the Suffolk County Children’s Advocacy Center. This agency as part of the District Attorney’s Office handles cases of physical and sexual violence against children.
• PACT clinicians are now involved with Chelsea police detectives in child sexual assault cases.  Clinicians are now paged by a detective, and respond immediately to a child victim’s caretakers.  Interventions are designed to provide immediate response to the crisis, familiarize caretakers with the legal, medical and mental health processes ahead, and most importantly to help caretakers manage their own and their children’s immediate emotional and safety needs.  This important initial contact greatly increases clinical follow up care for the child and family.
• PACT has initiated an interagency dialogue around improving access to services for children who set fires. 
• PACT presented the program to members of the Zonta Club of Chelsea.
• In October, The Chelsea Domestic Violence Task Force awarded Georgia Green the Public Service Award at its annual community breakfast in appreciation for her leadership working for community solutions to end domestic violence.

Program Data

• PACT has provided services to 712 families including 1435 children seen since 1998.
• In 2007, PACT was paged 137 times with an additional 51 cases referred and 23 cases received from other sources (log book, being at CPD, etc.) totaling 211 cases for the year. Out of these 211 cases, 275 children were involved.
• Over 50 percent of cases were seen in person or contacted by phone. PACT saw 50 families, contacted 67 families by phone, and left messages or sent pamphlets to the remaining 118 families.

In 2007, of the 50 families directly served by PACT;

• 104 children were involved.
• Seventy-five of those children witnessed domestic violence
• Substance abuse was involved in eleven cases
• 14 adults and three children were physically injured and four adults and two children required medical assistance
• Eleven 51-A’s were filed and 18 restraining orders were issued as a result of meeting with PACT clinicians

Safe Start Promising Approaches
Pam Miller, Ed.D, MSW, MGH Chelsea

The goal of Safe Start Promising Approaches (Safe Start) is to reduce the harmful effects on children of exposure to violence, as well as to enhance the delivery of services to children and families through effective community collaborations.  MGH Chelsea is one of 15 Safe Start sites nationally funded by the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.
 
Safe Start builds on the long-standing community partnerships that exist with the Chelsea Police Department, DSS, and HarborCOV.  These collaborations provide consistent opportunities for staff across agencies to share expertise and knowledge about the impact of children’s exposure to violence.  Reciprocal education and training sessions are offered and staff collaborate to expand, enhance, and develop policies and procedures to improve systems and facilitate referrals and communication with community partners.

Through a multi-disciplinary team of MGH Chelsea providers, Safe Start coordinates the extensive support, services, and resources required by children who have been exposed to violence and their caregivers.  These include:

• Improved capacity to identify and refer children and families exposed to violence to services.
• Linkages to needed medical care and additional health care resources.
• Individual and family mental health treatment.
• Group sessions for parents and children, developed with particular emphasis on attachment and affect regulation.
• Home visits to assess physical safety, child supervision, and exposure to media that can contain violent content, such as TV, videogames, and music.
• Services as needed through HAVEN, PACT, and the Child Protection Consultation.

The MGH Chelsea Family Violence Team includes multi-disciplinary health center staff and community partners from Chelsea, including DSS, the police, and the Boys and Girls Club.  During monthly meetings, providers engage in planning for Safe Start families facing particularly complex challenges. The team also regularly brainstorms about improving family interventions and providing new systems for interagency communication. Community members are often invited to use meetings as a forum to address topics about violence exposure, and guest speakers are frequent participants.  This year, Safe Start trainings for MGH Chelsea staff and community partners have included clinical training about attachment and self-regulation for older children and their caregivers, the science of early child development, and understanding sensory-motor integration issues.

2007 Data and Program Accomplishments

• Since its launch in June, 2006 Safe Start has received 147 referrals for children ranging in age from infancy to late adolescence.
• Safe Start recruitment events have been attended by over 50 different families. 
• Fourteen home visits have been completed.
• A comprehensive evaluation of the 15 Safe Start sites is on-going to assess the effectiveness of intervention approaches and develop methods by which to better understand the consequences of community collaboration.  The evaluation in Chelsea has thus far enrolled 26 families and followed them for up to a year. Comparison site families from Revere have also been enrolled. 
• Over a dozen groups for children and parents have served 42 different children.
• The Harbor Office of the Department of Social Services has collaborated on a plan to use Safe Start funding for programs on issues concerning racial disparities in treatment.
• The Chelsea Police Department has begun to use Safe Start funding to place more officers with families exposed to violence in order to assist both children and adults with criminal prosecution issues, and to purchase needed supplies to use with siblings and children when officers are assisting families.
  
  
  

HAVEN at MGH Chelsea
Marisol Coreas, HAVEN Advocate
Niza Troncoso, HAVEN Advocate

HAVEN at MGH Chelsea, part of the hospital-wide HAVEN program, works as part of the broader movement to end intimate partner abuse by improving and enhancing our health care response to patients, employees, and community members who have been impacted by abuse. HAVEN’s goal is to reduce the immediate impact of violence on survivors and their families, and to help individuals and families seek lives free of violence and abuse. HAVEN participates in the Chelsea community-wide Domestic Violence Task Force, multidisciplinary assessment team meetings at DSS, and in a community faith-based initiative. HAVEN is an active member of MGH Chelsea’s Safe Start Program and the Family Violence Team. 

Two bicultural HAVEN advocates train healthcare providers to ask patients about partner abuse sensitively and effectively. If a patient discloses abuse, the provider offers the services of a HAVEN Advocate, who works to empower survivors to better understand the dynamics and impact of abuse, increase their safety, review options, and heal from the abuse in their and their children’s lives. 

2007 Program Accomplishments

• HAVEN offered De Mujer a Mujer, a ten-week curriculum-based support group for Latinas confronting violence, including sessions about traditional roles within a family, STDs, and domestic violence.
• A HAVEN at MGH Chelsea advocate traveled to Peru to train providers in rural and urban health care centers in the use of the De Mujer a Mujer curriculum.
• A HAVEN advocate co-facilitated a mother-child group with a clinician from the Safe Start Initiative

Program Data

• Since its inception in 1997, HAVEN at MGH Chelsea has provided services to more than 672 clients, 72 percent of whom are Latina and 92 percent of whom have children. 
• 48 percent of their abusers are active users of alcohol or drugs, 31 percent have threatened to kill the patient, 15 percent have threatened the patient with weapons and 9 percent have actually harmed the patient with weapons. 
• Over 40 patients have participated in De Mujer a Mujer since the group began.